Arterial hypertension in Poland in 2002.

Arterial hypertension represents a serious medical, social and economic problem in Poland. Owing to a small number of studies concerning HT epidemiology in Poland and large differences in methodology, it is difficult to make an objective verification of the changes regarding principal parameters in our country within the last decade. Important programme for the assessment of the situation in our country is NATPOL PLUS, carried out in the year 2002 on a representative sample of 3051 adult Polish residents aged between 18 and 93 years, using the current diagnostic criteria for arterial hypertension (blood pressure readings obtained at three separate visits in cases of newly detected HT, different cuff sizes for different arm circumference, age range 18-93 years, rejection of first measurement during initial screening visit). Prevalence of HT in Poland is 29%, awareness-67%, and effectiveness of treatment-12%. This means that while HT affects about 8.4 million adult Poles, only 1 million of them get effective treatment. Moreover, as much as 8.7 million Poles have high normal blood pressure and they should apply active prevention. The awareness, detection and control of hypertension is much worse in men than in women. A series of NATPOL studies indicated over the period 1994-2002 a significant and rapid decrease in the awareness of one's own blood pressure among the adult Polish population, especially in small towns and villages, among less educated people, and in males.

Have rapid socioeconomic changes influenced awareness of blood pressure in Poland?

The aim of our study was to evaluate changes in awareness of blood pressure during transition into a market economy in Poland. Thus, in 1994, we conducted a cross-sectional survey based on a questionnaire interview on a sample of 2080 men (M) and women (F) aged 18 years and over. The subjects were selected from a Polish population by stratified and cluster random sampling with quotas by the Center for Social Research in Sopot. They were asked if they were aware of blood pressure. The results were analysed according to age, sex, education level, income and place of living. In September 1997 we carried out the same investigation on a new group of 1664 adults. In addition to the questionnaire, the blood pressure (three recordings at home) measurements were completed. The interviewers were well-trained medical students. Awareness of blood pressure has declined (P < 0.001) from 71% in 1994 to 65.5% in 1997. The highest decrease in awareness of blood pressure was observed among less educated people, as well as among people living in smaller cities and villages. The overall prevalence of hypertension was 25.9% by 'older' WHO criteria (BP > or =160/95 mm Hg or taking antihypertensive medication) and 44.5% by JNC VI criteria (BP > or =140/90 mm Hg or taking antihypertensive medication). Forty-six percent of hypertensive subjects classified by JNC VI criteria were previously known to be hypertensives and 54% were newly detected (F: 39%, M: 69%). Low awareness of blood pressure in Poland is the crucial factor of insufficient detectability of hypertension. Decline of awareness of blood pressure being the most significant among people representing lower social status, emphasises the need for urgent preventive measures.

Headache in patients with mild to moderate hypertension is generally not associated with simultaneous blood pressure elevation.

OBJECTIVE: Although headache is regarded a symptom of hypertension, its relation to blood pressure, especially in mild and moderate hypertension, is not clear. Thus, the aim of the study was to investigate whether headache in patients with mild to moderate hypertension may be attributed to simultaneous elevations in blood pressure. DESIGN AND METHODS: Ambulatory blood pressure monitoring (ABPM) was performed in patients (mean age 48 +/- 10 years, n = 150, 92 men, 58 women) classified, according to their office blood pressure, as stage 1 -2 hypertensives (JNC VI). Headache periods were recorded in patients' diaries. RESULTS: Headaches were generally not directly associated with blood pressure elevations in the studied group of stage 1-2 hypertensive patients because (i) blood pressure values from headache periods were not significantly higher than those from headache-free periods; (ii) blood pressure values directly preceding the pain were not significantly different from values at the beginning of headache; and (iii) in the vast majority of hypertensives, their maximal blood pressure values were recorded during headache-free periods. Moreover, in some instances, patients who showed maximal ABPM values during headache had relatively high blood pressure, i.e. > or = 180/110 mmHg. CONCLUSIONS: Our results did not support the opinion that headache experienced by stage 1-2 hypertensives was generally caused by simultaneous elevation in blood pressure. The direct mechanisms of headache in hypertension, as well as the relation between increments in blood pressure above 180/110 mmHg and headache, need further investigations.

[Evaluation of reproducibility of plethysmographic indices according to body posture, choice of forearm and method of measurement]. / Ocena powtarzalnosci wskazników pletyzmograficznych w zaleznosci od pozycji ciala, wyboru badanej konczyny oraz metody pomiaru.

The aim of the study was the analysis of the influence: a) body position (sitting vs. supine), b) choice of the arm (dominant vs. nondominant), c) variant of the method (classic vs. automatic) on plethysmographic indices describing forearm blood flow repeatability (arterial inflow--AI, fast blood flow--FBF, venous outflow VO, venous capacitance--VC). The study group included subjective healthy men, aged from 22 to 60 years. Individuals with body mass index (BMI) > 35 kg/m2 or treated pharmacologically weren't been included into examination. The indices of the forearm blood flow were calculated from the plethysmographic curve using the graphic technique: venous capacitance (VC), arterial inflow (AI), fast blood flow (FBF) and venous outflow (VO). We used relative repeatability coefficient (RRC) and coefficient of variation (CV) for assessing repeatability of obtained parameters. Repeatability of plethysmographic indices was better in supine position than in sitting one. RRC was respectively for supine vs. sitting position for VO: 0.41 vs. 0.68, for VC: 0.42 vs. 0.52 and for AI: 0.57 vs. 0.65. Plethysmographic indices VO, VC, AI were characterised by better repeatability when the exams were performed on the dominant arm. RRC was respectively for dominant vs. nondominant arm for VO: 0.68 vs. 0.71, for VC: 0.52 vs. 0.64 and for AI: 0.65 vs. 0.71. Coefficient of variation of arterial inflow assessed by conventional, automatic and by fast inflow was respectively 20%, 23% and 17%. The long-term repeatability of FBF estimated by RRC was 0.76 whereas CV yielded 17%. The same coefficient of variation was obtained when short-term repeatability was estimated-mean value CV was 17%, after rejection extremal values 11%. In conclusion the best repeatability was obtained when measurements were performed with automatic variant of method, in supine position, on dominant arm.

Heritability of plasma leptin levels: a twin study.

OBJECTIVE: To examine the influence of genetic factors on plasma leptin levels. SUBJECTS AND METHODS: We measured plasma leptin levels, body mass index and body fat distribution in healthy young female monozygotic (n = 19) and dizygotic (n = 14) twins. The twin zygosity was verified by determination of short tandem repeat and amplified fragment length polymorphism systems. The genetic analysis included analysis of variance-based and maximum likelihood-based methods. RESULTS: Plasma leptin levels were correlated significantly with body mass index (r = 0.59, P < 0.001), waist circumference (r = 0.54, P < 0.001) and hip circumference (r = 0.63, P < 0.001), but not with age (r = -0.17) or the waist:hip ratio (r = 0.02). The heritability estimates derived from intraclass correlations were significant for body mass index (P = 0.001), waist circumference (P = 0.004), hip circumference (P = 0.01) and plasma leptin levels (P = 0.005), but not for the waist:hip ratio (P = 0.22). In the maximum likelihood-based path analysis, heritability was estimated at 79% for body mass index and at 73% for plasma leptin levels. After adjustment for body mass index, the heritability estimate for leptin levels from the model-fitting approach was 55%. CONCLUSIONS: Genetic factors are major determinants of plasma leptin levels in humans and may account for as much as half of the variance in leptin levels.

[Pharmacotherapy of arterial hypertension and pharmacoeconomic aspects of hypotensive therapy in elderly patients in Poland]. / Leczenie farmakologiczne nadcisnienia tetniczego oraz wybrane aspekty farmakoekonomiczne terapii hipotensyjnej u chorych w starszym wieku w Polsce.

The aim of our study was to examine the use of pharmacological therapy and to evaluate the economical aspects of treating hypertension (HT) in elderly patients in Poland. Two hundred and sixty eight elderly persons (147 females, 121 males; mean age: 72.2 +/- 6.0 years) were selected from Polish population by stratified and cluster random sampling with quotas. BP measurement was performed 3 times every 2 minutes at respondents home. In the questionnaire, awareness of HT was assessed. Prevalence of hypertension among subjects aged 65 years and over by JNC VI criteria (SAP > or = 140 mm Hg, DAP > or = 90 mm Hg or hypotensive therapy) was 74%. Awareness of HT was equal to 61%. Eleven percent of all hypertensives were well controlled. Among hypertensives, 71% took prescribed antihypertensive drugs on a regular basis. Patients with HT were taking the following antihypertensive drugs: diuretics 16%, diuretics and reserpine 20%, beta-blockers 19%, ACE inhibitors 53%, calcium antagonists 30%, and other 3%. Newer drugs were prescribed in 7%, and multi-source (generic) products in 93%. The average cost of treatment with one drug was 147 PLN (37.5 USD) per year (newer drugs: 413 PLN; multi-source product 126 PLN). Assuming those data and number of elderly people in Poland (4.335 mln), we estimated that 3.208 mln of subjects have had hypertension according to JNC VI criteria. Only 1.957 mln of patients with HT have been detected and only 0.353 mln of hypertensives have been well controlled. The approximate global cost of antihypertensive drugs per year in elderly patients in Poland has been equal to 285 mln PLN (72.8 mln USD). In hypothetical situation with optimal (100%) detection and control of HT the global cost by the actual rate of regularity in taking drugs would increase to 569 mln PLN (145.3 mln USD). The prevalence of HT in elderly people in Poland is very high. In elderly hypertensives ACE inhibitors are used most often. More than 90% of prescribed drugs are multi-source products. An optimal improvement of HT detection and control would cause a two-fold augmentation of the costs of pharmacological therapy.

[The influence of 5-week relaxation therapy on arterial blood pressure in patients with borderline hypertension]. / Wplyw 5-tygodniowej terapii relaksacyjnej na wysokosc cisnienia tetniczego u chorych na nadcisnienie tetnicze graniczne.

The present study was performed to evaluate the influence of 5-week relaxation therapy on office and ambulatory blood pressure in young borderline hypertensives. Thirty patients were studied. The office blood pressure decreased significantly after 5 weeks of relaxation therapy (P < 0.001 for both systolic and diastolic blood pressure). Ambulatory monitoring revealed only a slight decrease of 24-hour blood pressure (P = 0.02). Our results indicate limited efficacy of relaxation therapy in treatment of borderline hypertensives.

[The influence of 5-week relaxation therapy on psychological state of patients with borderline hypertension]. / Ocena wplywu 5-tygodniowej terapii relaksacyjnej na stan psychiczny chorych na nadcisnienie tetnicze graniczne.

The aim of the present was to evaluate the influence of 5-week relaxation therapy on psychic state of patients with borderline hypertension. The study group consisted of 30 hypertensives. We observed significant changes in anxiety scale, defensiveness, self-confidence, intraception, nurturance, affiliation, heterosexuality, change and succorance scales. In conclusion, 5-week relaxation changes significantly psychological status of patients with borderline hypertension.

[Polymorphism of the ACE gene and left ventricular morphology and function in patients with borderline, mild and moderate hypertension]. / Polimorfizm genu ACE a morfologia i funkcja lewej komory serca u chorych z nadcisnieniem tetniczym granicznym, lagodnym i umiarkowanym.

It has been reported that the allel D of an insertion/deletion (I/D) polymorphism of the angiotensin I converting enzyme (ACE) gene is associated with the conditions of increased cardiovascular risk, including the left ventricular hypertrophy and the dysfunction. We examined the relation between the genotype of ACE gene and the left ventricular function in normotensives and in borderline, mild and moderate hypertensives. We investigated 128 subjects, 47 first-diagnosed untreated hypertensives and 81 normotensives. The M-mode and Doppler echocardiography were used to quantify LV mass and function. The insertion/deletion ACE polymorphism was identified using polymerase chain reaction. Left ventricular indexes of the morphology and function were analyzed. We compared ambulatory blood pressure profiles between all genotypes in both groups. There were no significant differences in indexes of the left ventricular hypertrophy in studied normotensives and borderline to mild hypertensives. Our results indicate that allel I might be associated with selected parameters of diastolic function, while allel D with selected parameters of systolic function, of the left ventricle. Results of this study suggest also probable relation between allel D and variability of the diastolic arterial pressure in both investigated groups.

Regression of left ventricular hypertrophy in hypertensive patients after 1 year of treatment with rilmenidine: a double-blind, randomized, controlled (versus nifedipine) study.

OBJECTIVE: To assess the effect of 1-year treatment with rilmenidine, an oxazoline compound that exerts its antihypertensive effects through binding to imidazoline receptors in the brainstem, on left ventricular hypertrophy (LVH) secondary to essential, mild-to-moderate hypertension [supine diastolic blood pressure (DBP)95-115 mmHg]. METHODS: We performed a double-blind, randomized, controlled (versus slow-release nifedipine) trial. Adjustment of treatment took place every month (M) between inclusion (MO) and an evaluation after 6 months (M6), then during M9 and after 1 year (M12) to achieve supine DBP values < or = 90 mmHg. Patients were dropped from our study if they had DBP> 95mmHg during two consecutive visits or DBP>115 mmHg on one occasion. The daily dosage of rilmenidine was 1 mg, and could be increased to 2 mg/day. The daily dosage of slow-release nifedipine was started from the beginning at the maximum dosage of 40 mg/day, so that there was no true adjustment of treatment despite the allocation of patients to a different unit in the case of DBP> 95 mmHg. The primary criterion was the change in left ventricular mass index (LVMI, g/m2), assessed by echocardiography, between MO and M12 for patients who completed the trial. RESULTS: After a 1-month placebo run-in period, 76 patients were selected and 73 were included (35 treated with rilmenidine and 38 treated with nifedipine). Fifteen patients withdrew from the study and two completed the study with a major deviation from protocol, leaving 56 patients (24 treated with rilmenidine and 32 treated with nifedipine) for a per-protocol analysis. Baseline demographic characteristics and history of arterial hypertension for the rilmenidine and nifedipine groups were similar, for included patients and for those taken into account for the per-protocol analysis. Between MO and M12, DBP in members of the per-protocol population was adequately controlled for those in the rilmenidine group (102.7+/-4.6 versus 88.5+/-7.1 mmHg, respectively) and for those in the nifedipine group (102.7+/-5.1 versus 85.6+/-79 mmHg, respectively). During MO, LVMI of patients in the rilmenidine group (176.9+/-41.3 g/m2) was slightly higher than that of patients in the nifedipine group (172.6+/-35.1 g/m2). During M12, LVMI was observed to have decreased both for patients in the rilmenidine group (to 154.8+/-40.2 g/m2, a decrease of 22.1+/-23.3 g/m2, P< 0.001) and for those in the nifedipine group (to 145.6+/-36.4 g/m2, a decrease of 26.9+/-29.5 g/m2, P< 0.001) but the difference between these two groups was not significant (P= 0.5). CONCLUSION: One-year treatment with a daily dosage of 1 or 2 mg rilmenidine achieves a significant reduction of left ventricular mass, which is not statistically different than that occurring with a daily dosage of 40 mg of slow-release nifedipine.

Ambulatory systolic blood pressure is related to the deletion allele of the angiotensin I converting enzyme gene in young normotensives with parental history of hypertension.

The aim of the present study was to evaluate the relationship between the angiotensin I converting enzyme (ACE) gene polymorphism and ambulatory blood pressure in young normotensive males with (n=45) and without (n=100) family history of hypertension. Twenty-four hour and daytime systolic blood pressure was significantly higher in subjects with a parental history of hypertension. Ambulatory blood pressure values did not differ significantly across ACE genotypes in subjects with negative family history of hypertension. In subjects with a parental history of hypertension, there was a significant positive association between the D allele of the ACE gene polymorphism and 24-h, daytime and nighttime systolic blood pressure. For twenty-four hour systolic blood pressure there was an average 9 mmHg difference between subjects with DD and II genotypes. The results indicate that in normotensive subjects with a genetic predisposition to hypertension, ambulatory systolic blood pressure is related to the D allele of the ACE gene.

No effect of genetic variation at the angiotensinogen locus on ambulatory blood pressure level in normotensive subjects.

The aim of the study was to evaluate the potential association between ambulatory blood pressure and the molecular variants T174M and M235T of the angiotensinogen gene in a random sample of young normotensive men (n = 145). The two point mutations were detected using restriction digests of a mispairing polymerase chain reaction product. Twenty-four-hour ambulatory blood pressure monitoring was performed with a SpaceLabs 90207 device. Ambulatory blood pressure levels did not vary according to T174M and M235T genotypes. When the subjects were grouped according to their blood pressure level (as indicated by tertiles of their 24-h ambulatory blood pressure), no significant differences in allele frequencies between the three groups were found. Our results indicate that the T174M and M235T molecular variants of the angiotensinogen gene have no major influence on ambulatory blood pressure in young normotensive subjects.

Genetic influences on insulinemia in normotensive twins.

The aim of this study was to establish the contribution of genetic factors to the variance of plasma insulin concentration in healthy, normotensive twins. Seventeen pairs of monozygotic (MZ) and 17 pairs of dizygotic (DZ) twins were investigated. The test of genetic variance revealed a significantly larger within-pair variance of fasting plasma insulin (FPI) and a relative insulin resistance (RIR) in the DZ twins, in comparison with the MZ twins. Both FPI and RIR had a higher intraclass correlation coefficient in the MZ twins than in the DZ twins; the corresponding heritability estimates were 0.54 for FPI and 0.66 for RIR. Adjusting for age, gender, and body mass index did not affect heritability estimates for either FPI or RIR. Our data indicate that genetic factors are important determinants of insulinemia in normal subjects, independent of body mass index.

The influence of exercise on albumin excretion rate in borderline hypertensives and in offspring of hypertensive parents.

We investigated exercise induced urinary albumin excretion rate (UAE)(ex-UAE) in patients with borderline hypertension (BH) compared to normotensives with positive-PFH and negative-NFH family history of hypertension. The study population consisted of 20 young, non-obese males with BH defined according to WHO criteria and confirmed by 24 h ambulatory blood pressure (ABP) and 40 healthy matched normotensives (PFH = 20 and NFH = 20). Twenty-four hour UAE was assessed by day and night time urine collection. BH and normotensive subjects performed a 20 min ergometric graded exercise test. The relationship between 24 h UAE, 24 h ABP and 2-D-echocardiographic left ventricular mass index (LVMI) were examined. The three groups did not differ in 24 h UAE. Exercise induced a significant increase in UAE only in BH. Exercise induced UAE was greater in BH compared to normotensives: BH = 54.3(21-125), PFH = 37.6(13-62), NFH = 9.7(0-35)micrograms/min, data expressed as median (I quartile-III quartile). Pooled data from all three groups showed a positive correlation between ex-UAE and systolic BP (SBP) during night time (by multiple regression analysis). In conclusion, BH without other known cardiovascular risk factors, moderate dynamic exercise induced an excessive increase in UAE.

Awareness and treatment of arterial hypertension in Poland.

In order to find out the general public's opinion on blood pressure (BP) control in Poland a poll was conducted on a representative sample of 2080 randomly selected subjects. Overall 71% of the subjects were aware of their BP level. The awareness of BP level increased progressively with age and education level. Among those who were aware of their BP level, 21% had hypertension. Only 43% of hypertensives were treated on a regular basis. Cigarettes were smoked by 33% of the patients. Only 16% of the hypertensives used a low-salt diet, and only 31% tried to reduce animal fat in their diet. More than a half of the hypertensives did not adjust their lifestyle and daily habits to the disease. In conclusion, these results indicate that the prevention and treatment of hypertension in Poland should be urgently improved.

Ambulatory blood pressure and insulinaemia in different clinical conditions.

The aim of our study was to examine the relation between insulin and ambulatory blood pressure (ABPM) in several clinical conditions. ABPM monitoring was performed with Spacelabs device. Fasting plasma insulin (FPI) was measured by radioimmunoassay. In young, non-obese normotensive subjects (n = 32) there were correlations between FPI and both asleep (r = 0.61, p < 0.001), and awake systolic ABPM (r = 0.44, p < 0.01). We have not observed any significant correlation between FPI and ABP in borderline hypertensives or in patients with established hypertension. In a group of 21 hypertensive type 2 diabetics (age 52 +/- 8 years) there was no significant correlation between FPI and ABPM. Among 14 normotensive type 1 diabetics (age 31 +/- 7 years, diabetes duration > 10 years) there was a significant negative correlation between the daily dose of insulin and 24-h systolic ABPM (r =-0.63, p < 0.02). In 20 patients with renal failure on chronic haemodialysis we have found a significant negative correlation between FPI and 24-h systolic APBM (r = 0.80, p < 0.001) and 24-h diastolic ABPM (r = -0.55, p < 0.05). Similar negative correlations were found in 20 nondialysed subjects with moderate chronic renal failure. Taken together, our results suggest that insulin could reveal its hypertensive or vasodilatory effect which depends on a clinical condition of the studied subjects.

The clinical course of untreated asymptomatic bacteriuria in diabetic patients--14-year follow-up.

The present study aimed at accessing the natural history of untreated asymptomatic bacteriuria in diabetic patients observed for 14 years. Two groups of diabetic patients were examined. Group I comprised 53 patients with significant bacteriuria, without clinical symptoms of urinary tract infection. Group II consisted of 54 patients with sterile urine. All patients were clinically and bacteriologically examined every 3-6 months for 14 years. The results obtained in this study have proved that clinical symptoms of acute pyelonephritis occur with similar frequency in both groups (group I-6, group II-5 cases). No deterioration of kidney function was found. Arterial hypertension did not differ significantly in both groups at the beginning and end of the follow-up. The usefulness of antibacterial treatment of asymptomatic bacteriuria in diabetic patients is not adequately documented.

Renin-aldosterone regulation during upright posture in young men with mitral valve prolapse syndrome.

Previous studies have shown that symptom complex in patients with mitral valve prolapse syndrome (MVPS) may result from various forms of autonomic dysfunction. However, the interaction between adrenergic activity and renin release has not been studied. The purpose of this investigation was to assess changes in plasma renin activity (PRA) and plasma aldosterone in response to prolonged orthostatic stimulation in 19 young men with MVPS when compared to age- and sex-matched 20 control subjects. Heart rate was measured, and blood samples for PRA and aldosterone were obtained in the supine position and 90 min after assuming an upright position and slow walk. With posture the heart rate increase was greater in patients with MVPS in comparison with control subjects (19 +/- 9 vs. 12 +/- 8 beats per min, p < 0.05). Also an increase of PRA during upright activity was significantly greater in patients with MVPS (control 1.0 +/- 0.5 ng angiotensin I/mlxh, MVPS 1.8 +/- 1.7 ng angiotensin I/mlxh; p < 0.05). A significant correlation (r = 0.52, p < 0.05) was found between a rise of heart rate and PRA in patients with MVPS, but not in the control subjects. During prolonged upright activity aldosterone increased significantly in control subjects (at rest 74 +/- 41 pg/ml, with posture 98 +/- 68 pg/ml, p < 0.05) but did not change in patients with MVPS (at rest 64 +/- 29 pg/ml, with posture 67 +/- 26 pg/ml, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

[Renal hemodynamics in patients with short-lasting diabetes mellitus type I]. / Hemodynamika nerek u chorych z krótkotrwala cukrzyca typu 1.

Parameters of renal hemodynamics have been determined in 30 male patients with diabetes mellitus, lasting for 1-24 months (mean 0.9 +/- 0.7 year), and in 19 healthy men of the same age. Patients' age ranged from 17 to 33 years (mean 27.5 +/- 5.0). All examined subjects have been normotensive (according to WHO criteria). Glomerula filtration rate with the aid of 51CrEDTA, and ERPF with 125I-hippurate have been determined. Mean GFR values have been significantly higher in diabetics than that in healthy men (142.9 +/- 29 vs 118 +/- 20 ml/min per 1.73 m2). Hyperfiltration (GFR over 140 ml per minute) has been found in 15 patients (50%). ERPF has also been higher in diabetic patients (929.2 +/- 230 vs 821.5 +/- 192 ml/min). This difference has been insignificant. No correlation between arterial blood pressure and GFR, ERPF, filtration fraction (FF), and RVR has been found.

Increased urinary C-peptide and albumin excretion in juvenile borderline hypertensives.

The study was designed to evaluate the urinary excretion of C-peptide and albumin, and urinary N-acetyl-beta-D-glucosaminidase (NAG) activity in juvenile borderline hypertensives. The second aim was to examine the relationship between these variables and ambulatory blood pressure level and variability. The study group consisted of 21 non-obese males consecutively chosen from patients with borderline hypertension, defined by sphygmanometer readings, examined in our outpatient clinic. All subjects collected separately their day-time and night-time urines during the period of ambulatory blood pressure monitoring. In 16 patients, who were considered to have "sustained" borderline hypertension, both 24-h urinary C-peptide excretion and 24-h UAE were significantly increased in comparison to those of the controls, while NAG activity did not differ significantly between the two groups. UAE was significantly lower at night than during the day in both borderline hypertensives and controls. Twenty-four-hour UAE in borderline hypertensives correlated significantly with the ambulatory blood pressure variability, but not with the average blood pressure level. These results suggest that the 24-h insulin secretion rate estimated by means of urinary C-peptide excretion is significantly increased in "sustained" borderline hypertensives. Elevated UAE in juvenile borderline hypertensives can be explained by a possible direct effect of systemic blood pressure variability on albuminuria.